THE INFLUENCE OF ANTENATAL AND MATERNAL FACTORS ON STILLBIRTHS AND NEONATAL DEATHS IN NEW SOUTH WALES, AUSTRALIA

This study identified the influences of maternal socio-demographic and antenatal factors on stillbirths and neonatal deaths in New South Wales, Australia. Bivariate and multivariate analyses were used to explore the association of selected antenatal and maternal characteristics with stillbirths and neonatal deaths. The findings of this study showed that stillbirths and neonatal deaths significantly varied by infant sex, maternal age, Aboriginality, maternal country of birth, socioeconomic status, parity, maternal smoking behaviour during pregnancy, maternal diabetes mellitus, maternal hypertension, antenatal care, plurality of birth, low birth weight, place of birth, delivery type, maternal deaths and small gestational age. First-born infants, twins and infants born to teenage mothers, Aboriginal mothers, those who smoked during the pregnancy and those of lower socioeconomic status were at increased risk of stillbirths and neonatal deaths. The most common causes of stillbirths were conditions originating in the perinatal period: intrauterine hypoxia and asphyxia. Congenital malformations, including deformities and chromosomal abnormalities, and disorders related to slow fetal growth, short gestation and low birth weight were the most common causes of neonatal deaths. The findings indicate that very low birth weight (less than 2000 g) contributed 75·6% of the population-attributable risks to stillbirths and 59·4% to neonatal deaths. Low gestational age (less than 32 weeks) accounted for 77·7% of stillbirths and 87·9% of neonatal deaths. The findings of this study suggest that in order to reduce stillbirths and neonatal deaths, it is essential to include strategies to predict and prevent prematurity and low birth weight, and that there is a need to focus on anti-smoking campaigns during pregnancy, optimizing antenatal care and other healthcare programmes targeted at the socially disadvantaged populations identified in this study.

[1]  William McGuire,et al.  Epidemiology of preterm birth , 2004, BMJ : British Medical Journal.

[2]  D. Tudehope,et al.  Classification of perinatal deaths: Development of the Australian and New Zealand classifications , 2004, Journal of paediatrics and child health.

[3]  Jeffrey S. Robinson,et al.  Stillbirth and neonatal outcomes in South Australia, 1991-2000. , 2003, American journal of obstetrics and gynecology.

[4]  M. Coory.  Can a mortality excess in remote areas of Australia be explained by Indigenous status? A case study using neonatal mortality in Queensland , 2003, Australian and New Zealand journal of public health.

[5]  A. Bauman,et al.  MATERNAL AND NEONATAL FACTORS INFLUENCING PREMATURE BIRTH AND LOW BIRTH WEIGHT IN AUSTRALIA , 2003, Journal of Biosocial Science.

[6]  N. Badawi,et al.  Gastroschisis: determinants of neonatal outcome , 2003, Pediatric Surgery International.

[7]  Shiliang Liu,et al.  Analysis of perinatal mortality and its components: time for a change? , 2002, American journal of epidemiology.

[8]  J. Morris,et al.  Trends in twin births in New South Wales, Australia, 1990–1999 , 2002, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[9]  G. Dekker,et al.  Health Inequalities: Teenage pregnancy: trends, characteristics and outcomes in South Australia and Australia , 2002, Australian and New Zealand Journal of Public Health.

[10]  Shiliang Liu,et al.  Relationship of prenatal diagnosis and pregnancy termination to overall infant mortality in Canada. , 2002, JAMA.

[11]  S. Cnattingius,et al.  The influence of socioeconomic status on stillbirth risk in Sweden. , 2001, International journal of epidemiology.

[12]  M. Humphrey,et al.  Differing influences on Aboriginal and non‐Aboriginal neonatal phenotypes: a prospective study , 2001, The Medical journal of Australia.

[13]  Jeffrey S. Robinson,et al.  The contribution of maternal smoking to preterm birth, small for gestational age and low birthweight among Aboriginal and non‐Aboriginal births in South Australia , 2001, The Medical journal of Australia.

[14]  A. Reid.  Neonatal mortality and stillbirths in early twentieth century Derbyshire, England , 2001, Population studies.

[15]  D. Mackerras.  Size for gestation in Aboriginal babies: a comparison of two papers , 2000, Australian and New Zealand journal of public health.

[16]  J. Bai,et al.  Profile of Maternal Smokers and Their Pregnancy Outcomes in South Western Sydney , 2000, The journal of obstetrics and gynaecology research.

[17]  M. Kramer,et al.  Infant mortality by gestational age and birth weight in Canadian provinces and territories, 1990-1994 births. , 2000, Chronic Diseases in Canada.

[18]  K. Leveno,et al.  Birth weight in relation to morbidity and mortality among newborn infants. , 1999, The New England journal of medicine.

[19]  N. Matsaniotis,et al.  Sociodemographic determinants of low birthweight in Greece: a population study. , 1999, Paediatric and perinatal epidemiology.

[20]  M. Coory.  Gestational-age-specific stillbirth risk among Australian Aborigines. , 1998, International journal of epidemiology.

[21]  A. Bauman,et al.  How Well Does Epidemiological Evidence Hold For The Relationship Between Smoking and Adverse Obstetric Outcomes in New South Wales? , 1997, The Australian & New Zealand journal of obstetrics & gynaecology.

[22]  J. Lumley,et al.  Trends in Stillbirths and Neonatal Deaths for Very Pre‐Term Infants (<32 weeks'Gestation) Bora in Victoria, 1986–1993 , 1997, The Australian & New Zealand journal of obstetrics & gynaecology.

[23]  A. Child,et al.  Pregnancy outcomes in urban Aboriginal women , 1996, The Medical journal of Australia.

[24]  N. French,et al.  Very preterm birth–a regional study. Part 2: The very preterm infant , 1996, British journal of obstetrics and gynaecology.

[25]  G. Singh,et al.  Infant mortality in the United States: trends, differentials, and projections, 1950 through 2010. , 1995, American journal of public health.

[26]  R. Windsor,et al.  The impact on infant birth weight and gestational age of cotinine-validated smoking reduction during pregnancy. , 1993, JAMA.

[27]  D. Hosmer,et al.  Applied Logistic Regression , 1991 .

[28]  C. deCosta.  Pregnancy outcomes in Lebanese-born women in western Sydney. , 1988 .

[29]  J. Becerra,et al.  Maternal smoking and low birthweight in the reproductive history of women in Puerto Rico, 1982. , 1988, American journal of public health.

[30]  G H Land,et al.  The effects of maternal smoking on fetal and infant mortality. , 1988, American journal of epidemiology.

[31]  C. D. de Costa.  Pregnancy outcomes in Lebanese-born women in western Sydney. , 1988, The Medical journal of Australia.

[32]  M S Kramer,et al.  Determinants of low birth weight: methodological assessment and meta-analysis. , 1987, Bulletin of the World Health Organization.

[33]  H. Hein,et al.  The changing pattern of neonatal mortality in a regionalized system of perinatal care. , 1986, American journal of diseases of children.

[34]  C. deCosta.  Congenital abnormalities and consanguinity. , 1986 .

[35]  C. D. de Costa,et al.  Congenital abnormalities and consanguinity , 1986, The Medical journal of Australia.

[36]  D P Byar,et al.  Estimating the population attributable risk for multiple risk factors using case-control data. , 1985, American journal of epidemiology.

[37]  M C McCormick,et al.  The contribution of low birth weight to infant mortality and childhood morbidity. , 1985, The New England journal of medicine.

[38]  McIntosh Id.  Smoking and pregnancy: attributable risks and public health implications. , 1984 .

[39]  I. D. McIntosh.  Smoking and pregnancy: attributable risks and public health implications. , 1984, Canadian journal of public health = Revue canadienne de sante publique.